Biomedical QA

Biomedical knowledge graphs (KGs) treat disease associations as static facts, but temporal information is crucial for clinical reasoning, e.g., a symptom diagnostic of one disease at age 3 may imply a different disease at age 13. Existing KGs such as PrimeKG, Hetionet, and iKraph do not encode when a finding becomes clinically relevant over the course of a disease. This limits their usefulness for longitudinal clinical reasoning and retrieval augmentation. We introduce ChronoMedKG, a temporal biomedical knowledge graph that contains 460,497 evidence-linked triples (filtered from 13M raw extractions) covering 13,431 diseases. Each association is tied to temporal components like onset window or progression stage, which are backed by PMID-traceable evidence and a multi-signal credibility score. The graph is constructed through a disease-autonomous multi-agent pipeline in which multiple frontier LLMs independently extract knowledge from PubMed and PMC literature. Only those relations are kept that are supported by multi-model consensus, survive credibility filtering, as well as ontology alignment. ChronoMedKG scored 92.7% agreement against Orphadata and adds temporal grounding for 6,250 diseases absent from HPOA, Orphadata, and Phenopackets, including 1,657 Orphanet-coded rare diseases. We further introduce ChronoTQA, a benchmark of 3,341 questions across eight task types (six temporal plus two static controls), with a 12-question supplementary probe. Frontier LLMs lose roughly 30 points moving from static to temporal questions; ChronoMedKG retrieval rescues 47-65% of their long-tail failures, against 17-29% for HPOA-RAG. As such, ChronoMedKG provides a crucial temporal axis for retrieval-augmented clinical systems that was previously absent.

Biomedical question answering often requires decisions from retrieved literature whose relevance, quality, and support for candidate answers are uneven. Most retrieval-augmented large language model (LLM) methods feed this literature to the model as flat text, leaving evidence reliability and remaining uncertainty largely implicit. We propose BELIEF, a structured evidence modeling and uncertainty-aware fusion framework for closed-set biomedical question answering. Rather than treating retrieved documents as undifferentiated context, BELIEF converts them into evidence objects that record clinical attributes, source quality, question relevance, support strength, and the associated candidate hypothesis. These evidence objects provide a shared basis for two complementary reasoning paths. The symbolic path constructs reliability-weighted basic probability assignments based on Dempster--Shafer (D-S) theory over a finite answer space and performs uncertainty-aware symbolic evidence fusion to estimate belief and residual uncertainty. The neural path uses the same structured evidence for LLM-based semantic inference, while a reliability-aware arbitration module reconciles the symbolic and neural outputs according to belief strength, uncertainty, evidence reliability, and semantic consistency. Experiments on PubMedQA, MedQA, and MedMCQA with five general-purpose LLM backbones show that BELIEF obtains the best result in 25 of 30 backbone--dataset--metric settings. Comparisons with biomedical-domain models indicate that BELIEF is competitive on MedQA and MedMCQA, while specialized biomedical pretraining remains advantageous on PubMedQA. Ablation, complementarity, uncertainty-stratified, and cost analyses further show that BELIEF improves retrieved-evidence utilization by making evidence structure, path disagreement, and decision uncertainty explicit.

Biomedical retrieval-augmented large language models (LLMs) often face evidence that is incomplete, misleading, or internally contradictory, yet evaluation usually emphasizes answer accuracy under helpful context rather than reliability under conflict. Using HealthContradict, we evaluate six open-weight LLMs under five controlled evidence conditions: no retrieved context, correct-only context, incorrect-only context, and two mixed conditions containing both correct and contradictory documents in opposite orders. In this conflicting-evidence order contrast, where the same two documents are both present and only their order is reversed, accuracy drops for every model and 11.4%--25.2% of predictions flip. To support abstention in these difficult cases, we also evaluate a conflict-aware abstention score that combines model confidence with a detector of evidence conflict. In the two hardest conditions, this score improves selective accuracy over confidence-only, with mean gains of 7.2--33.4 points in incorrect-only (IC') and 3.6--14.4 points in incorrect-first conflicting (ICC') conditions across 75%, 50%, and 25% coverage. These results show that conflicting biomedical evidence is both an uncertainty and robustness problem and motivate evaluation and abstention methods that explicitly account for evidence disagreement.

Evaluating large language models (LLMs) in the biomedical domain requires benchmarks that can distinguish reasoning from pattern matching and remain discriminative as model capabilities improve. Existing biomedical question answering (QA) benchmarks are limited in this respect. Multiple-choice formats can allow models to succeed through answer elimination rather than inference, while widely circulated exam-style datasets are increasingly vulnerable to performance saturation and training data contamination. Multi-hop reasoning, defined as the ability to integrate information across multiple sources to derive an answer, is central to clinically meaningful tasks such as diagnostic support, literature-based discovery, and hypothesis generation, yet remains underrepresented in current biomedical QA benchmarks. MedHopQA is a disease-centered multi-hop reasoning benchmark consisting of 1,000 expert-curated question-answer pairs introduced as a shared task at BioCreative IX. Each question requires synthesis of information across two distinct Wikipedia articles, and answers are provided in an open-ended free-text format. Gold annotations are augmented with ontology-grounded synonym sets from MONDO, NCBI Gene, and NCBI Taxonomy to support both lexical and concept-level evaluation. MedHopQA was constructed through a structured process combining human annotation, triage, iterative verification, and LLM-as-a-judge validation. To reduce leaderboard gaming and contamination risk, the 1,000 scored questions are embedded within a publicly downloadable set of 10,000 questions, with answers withheld, on a CodaBench leaderboard. MedHopQA provides both a benchmark and a reusable framework for constructing future biomedical QA datasets that prioritize compositional reasoning, saturation resistance, and contamination resistance as core design constraints.

Multi-hop question answering (QA) remains a significant challenge in the biomedical domain, requiring systems to integrate information across multiple sources to answer complex questions. To address this problem, the BioCreative IX MedHopQA shared task was designed to benchmark in multi-hop reasoning for large language models (LLMs). We developed a novel dataset of 1,000 challenging QA pairs spanning diseases, genes, and chemicals, with particular emphasis on rare diseases. Each question was constructed to require two-hop reasoning through the integration of information from two distinct Wikipedia pages. The challenge attracted 48 submissions from 13 teams. Systems were evaluated using both surface string comparison and conceptual accuracy (MedCPT score). The results showed a substantial performance gap between baseline LLMs and enhanced systems. The top-ranked submission achieved an 89.30% F1 score on the MedCPT metric and an 87.30% exact match (EM) score, compared with 67.40% and 60.20%, respectively, for the zero-shot baseline. A central finding of the challenge was that retrieval-augmented generation (RAG) and related retrieval-based strategies were critical for strong performance. In addition, concept-level evaluation improved answer assessment when correct responses differed in surface form. The MedHopQA dataset is publicly available to support continued progress in this important area. Challenge materials: https://www.ncbi.nlm.nih.gov/research/bionlp/medhopqa and benchmark https://www.codabench.org/competitions/7609/

The MedHopQA challenge presents a critical test for Large Language Models (LLMs): complex, multi-hop reasoning in the high-stakes biomedical domain. This paper details our direct API-based evaluation of Google's Gemini Flash models, focusing on the impact of advanced prompt engineering. We designed a sophisticated, multi-component prompt for Gemini 2.0 Flash that combined role-playing, explicit multi-shot Chain-of-Thought (CoT) examples, and detailed formatting rules. Our best run, using this complex prompt, achieved a Concept Level Score of 0.720. This result dramatically outperformed a baseline prompt which scored only 0.565. Remarkably, this performance on the efficient Gemini 2.0 Flash was almost identical to the result from the next-generation Gemini 2.5 Flash. Our findings demonstrate that sophisticated prompt design is a critical factor for unlocking the full reasoning capabilities of modern LLMs.

Retrieval-Augmented Generation (RAG) offers a well-established path to grounding large language model (LLM) outputs in external knowledge, yet the question of which retrieval strategy works best in a high-stakes domain such as biomedicine has not received the controlled, multi-metric treatment it deserves. This paper presents a systematic empirical comparison of five retrieval strategies -- Dense Vector Search, Hybrid BM25 + Dense retrieval, Cross-Encoder Reranking, Multi-Query Expansion, and Maximal Marginal Relevance (MMR) -- within a biomedical question-answering RAG pipeline. All strategies share a fixed generation model (GPT-4o-mini), a common vector store (ChromaDB), and OpenAI's text-embedding-3-small embeddings, ensuring that observed differences are attributable to retrieval alone. Evaluation is conducted on 250 question-answer pairs drawn from a preprocessed subset of the BioASQ benchmark (rag-mini-bioasq) using four DeepEval metrics: contextual precision, contextual recall, faithfulness, and answer relevancy, each reported with 95% confidence intervals. A no-context ablation is included as a lower bound. Cross-Encoder Reranking achieves the best composite score (0.827) and highest contextual precision (0.852), confirming that query-document interaction yields measurable retrieval gains. Multi-Query Expansion, despite its recall-oriented design, produces the weakest contextual precision (0.671), suggesting naive query diversification introduces retrieval noise. MMR sacrifices answer relevancy for diversity, while the Dense baseline (composite 0.822) falls within 0.005 points of the top strategy. All RAG conditions dramatically outperform the no-context ablation on answer relevancy (0.658-0.701 vs. 0.287), confirming the practical value of retrieval. The full pipeline, hyperparameters, and evaluation code are publicly available.

This paper presents a principled and scalable framework for systematically generating complex Question Answering (QA) data. In the core of this framework is a graphlet-anchored generation process, where small subgraphs from a Knowledge Graph (KG) are used in a structured prompt to control the complexity and ensure the factual grounding of questions generated by Large Language Models. The first instantiation of this framework is BioGraphletQA, a new biomedical KGQA dataset of 119,856 QA pairs. Each entry is grounded in a graphlet of up to five nodes from the OREGANO KG, with most of the pairs being enriched with relevant document snippets from PubMed. We start by demonstrating the framework's value and the dataset's quality through evaluation by a domain expert on 106 QA pairs, confirming the high scientific validity and complexity of the generated data. Secondly, we establish its practical utility by showing that augmenting downstream benchmarks with our data improves accuracy on PubMedQA from 49.2% to 68.5% in a low-resource setting, and on MedQA from a 41.4% baseline to 44.8% in a full-resource setting. Our framework provides a robust and generalizable solution for creating critical resources to advance complex QA tasks, including MCQA and KGQA. All resources supporting this work, including the dataset (https://zenodo.org/records/17381119) and framework code (https://github.com/ieeta-pt/BioGraphletQA), are publicly available to facilitate use, reproducibility and extension.

Continuous glucose monitors (CGMs) used in diabetes care collect rich personal health data that could improve day-to-day self-management. However, current patient platforms only offer static summaries which do not support inquisitive user queries. Large language models (LLMs) could enable free-form inquiries about continuous glucose data, but deploying them over sensitive health records raises privacy and accuracy concerns. In this paper, we present CGM-Agent, a privacy-preserving framework for question answering over personal glucose data. In our design, the LLM serves purely as a reasoning engine that selects analytical functions. All computation occurs locally, and personal health data never leaves the user's device. For evaluation, we construct a benchmark of 4,180 questions combining parameterized question templates with real user queries and ground truth derived from deterministic program execution. Evaluating 6 leading LLMs, we find that top models achieve 94% value accuracy on synthetic queries and 88% on ambiguous real-world queries. Errors stem primarily from intent and temporal ambiguity rather than computational failures. Additionally, lightweight models achieve competitive performance in our agent design, suggesting opportunities for low-cost deployment. We release our code and benchmark to support future work on trustworthy health agents.

Trustworthiness and transparency are essential for the clinical adoption of artificial intelligence (AI) in healthcare and biomedical research. Recent deep research systems aim to accelerate evidence-grounded scientific discovery by integrating AI agents with multi-hop information retrieval, reasoning, and synthesis. However, most existing systems lack explicit and inspectable criteria for evidence appraisal, creating a risk of compounding errors and making it difficult for researchers and clinicians to assess the reliability of their outputs. In parallel, current benchmarking approaches rarely evaluate performance on complex, real-world medical questions. Here, we introduce DeepER-Med, a Deep Evidence-based Research framework for Medicine with an agentic AI system. DeepER-Med frames deep medical research as an explicit and inspectable workflow of evidence-based generation, consisting of three modules: research planning, agentic collaboration, and evidence synthesis. To support realistic evaluation, we also present DeepER-MedQA, an evidence-grounded dataset comprising 100 expert-level research questions derived from authentic medical research scenarios and curated by a multidisciplinary panel of 11 biomedical experts. Expert manual evaluation demonstrates that DeepER-Med consistently outperforms widely used production-grade platforms across multiple criteria, including the generation of novel scientific insights. We further demonstrate the practical utility of DeepER-Med through eight real-world clinical cases. Human clinician assessment indicates that DeepER-Med's conclusions align with clinical recommendations in seven cases, highlighting its potential for medical research and decision support.

While Large Language Models (LLMs) have demonstrated high proficiency on English-centric medical examinations, their performance often declines when faced with non-English languages and multimodal diagnostic tasks. This study protocol describes the development of EuropeMedQA, the first comprehensive, multilingual, and multimodal medical examination dataset sourced from official regulatory exams in Italy, France, Spain, and Portugal. Following FAIR data principles and SPIRIT-AI guidelines, we describe a rigorous curation process and an automated translation pipeline for comparative analysis. We evaluate contemporary multimodal LLMs using a zero-shot, strictly constrained prompting strategy to assess cross-lingual transfer and visual reasoning. EuropeMedQA aims to provide a contamination-resistant benchmark that reflects the complexity of European clinical practices and fosters the development of more generalizable medical AI.

Incorporating large language models (LLMs) in medical question answering demands more than high average accuracy: a model that returns substantively different answers each time it is queried is not a reliable medical tool. Online health communities such as Reddit have become a primary source of medical information for millions of users, yet they remain highly susceptible to misinformation; deploying LLMs as assistants in these settings amplifies the need for output consistency alongside correctness. We present a practical, open-source evaluation framework for assessing small, locally-deployable open-weight LLMs on medical question answering, treating reproducibility as a first-class metric alongside lexical and semantic accuracy. Our pipeline computes eight quality metrics, including BERTScore, ROUGE-L, and an LLM-as-judge rubric, together with two within-model reproducibility metrics derived from repeated inference (N=10 runs per question). Evaluating three models (Llama 3.1 8B, Gemma 3 12B, MedGemma 1.5 4B) on 50 MedQuAD questions (N=1,500 total responses) reveals that despite low-temperature generation (T=0.2), self-agreement across runs reaches at most 0.20, while 87-97% of all outputs per model are unique -- a safety gap that single-pass benchmarks entirely miss. The clinically fine-tuned MedGemma 1.5 4B underperforms the larger general-purpose models on both quality and reproducibility; however, because MedGemma is also the smallest model, this comparison confounds domain fine-tuning with model scale. We describe the methodology in sufficient detail for practitioners to replicate or extend the evaluation for their own model-selection workflows. All code and data pipelines are available at https://github.com/aviad-buskila/llm_medical_reproducibility.

Large language models (LLMs) have demonstrated strong capabilities in medical question answering; however, purely parametric models often suffer from knowledge gaps and limited factual grounding. Retrieval-augmented generation (RAG) addresses this limitation by integrating external knowledge retrieval into the reasoning process. Despite increasing interest in RAG-based medical systems, the impact of individual retrieval components on performance remains insufficiently understood. This study presents a systematic evaluation of retrieval-augmented medical question answering using the MedQA USMLE benchmark and a structured textbook-based knowledge corpus. We analyze the interaction between language models, embedding models, retrieval strategies, query reformulation, and cross-encoder reranking within a unified experimental framework comprising forty configurations. Results show that retrieval augmentation significantly improves zero-shot medical question answering performance. The best-performing configuration was dense retrieval with query reformulation and reranking achieved 60.49% accuracy. Domain-specialized language models were also found to better utilize retrieved medical evidence than general-purpose models. The analysis further reveals a clear tradeoff between retrieval effectiveness and computational cost, with simpler dense retrieval configurations providing strong performance while maintaining higher throughput. All experiments were conducted on a single consumer-grade GPU, demonstrating that systematic evaluation of retrieval-augmented medical QA systems can be performed under modest computational resources.

The injection of domain-specific knowledge is crucial for adapting language models (LMs) to specialized fields such as biomedicine. While most current approaches rely on unstructured text corpora, this study explores two complementary strategies for leveraging structured knowledge from the UMLS Metathesaurus: (i) Continual pretraining that embeds knowledge into model parameters, and (ii) Graph Retrieval-Augmented Generation (GraphRAG) that consults a knowledge graph at inference time. We first construct a large-scale biomedical knowledge graph from UMLS (3.4 million concepts and 34.2 million relations), stored in Neo4j for efficient querying. We then derive a ~100-million-token textual corpus from this graph to continually pretrain two models: BERTUMLS (from BERT) and BioBERTUMLS (from BioBERT). We evaluate these models on six BLURB (Biomedical Language Understanding and Reasoning Benchmark) datasets spanning five task types and evaluate GraphRAG on the two QA (Question Answering) datasets (PubMedQA, BioASQ). On BLURB tasks, BERTUMLS improves over BERT, with the largest gains on knowledge-intensive QA. Effects on BioBERT are more nuanced, suggesting diminishing returns when the base model already encodes substantial biomedical text knowledge. Finally, augmenting LLaMA 3-8B with our GraphRAG pipeline yields over than 3 points accuracy on PubMedQA and 5 points on BioASQ without any retraining, delivering transparent, multi-hop, and easily updated knowledge access. We release the processed UMLS Neo4j graph to support reproducibility.

Trustworthy biomedical question answering (QA) systems must not only provide accurate answers but also justify them with current, verifiable evidence. Retrieval-augmented approaches partially address this gap but lack mechanisms to iteratively refine poor queries, whereas self-reflection methods kick in only after full retrieval is completed. In this context, we introduce PubMed Reasoner, a biomedical QA agent composed of three stages: self-critic query refinement evaluates MeSH terms for coverage, alignment, and redundancy to enhance PubMed queries based on partial (metadata) retrieval; reflective retrieval processes articles in batches until sufficient evidence is gathered; and evidence-grounded response generation produces answers with explicit citations. PubMed Reasoner with a GPT-4o backbone achieves 78.32% accuracy on PubMedQA, slightly surpassing human experts, and showing consistent gains on MMLU Clinical Knowledge. Moreover, LLM-as-judge evaluations prefer our responses across: reasoning soundness, evidence grounding, clinical relevance, and trustworthiness. By orchestrating retrieval-first reasoning over authoritative sources, our approach provides practical assistance to clinicians and biomedical researchers while controlling compute and token costs.

Existing automatic scientific question generation studies mainly focus on single-document factoid QA, overlooking the inter-document reasoning crucial for scientific understanding. We present AIM-SciQA, an automated framework for generating multi-document, multi-hop scientific QA datasets. AIM-SciQA extracts single-hop QAs using large language models (LLMs) with machine reading comprehension and constructs cross-document relations based on embedding-based semantic alignment while selectively leveraging citation information. Applied to 8,211 PubMed Central papers, it produced 411,409 single-hop and 13,672 multi-hop QAs, forming the IM-SciQA dataset. Human and automatic validation confirmed high factual consistency, and experimental results demonstrate that IM-SciQA effectively differentiates reasoning capabilities across retrieval and QA stages, providing a realistic and interpretable benchmark for retrieval-augmented scientific reasoning. We further extend this framework to construct CIM-SciQA, a citation-guided variant achieving comparable performance to the Oracle setting, reinforcing the dataset's validity and generality.

Retrieval-Augmented Generation (RAG) significantly improves the factuality of Large Language Models (LLMs), yet standard pipelines often lack mechanisms to verify inter- mediate reasoning, leaving them vulnerable to hallucinations in high-stakes domains. To address this, we propose a domain-specific RAG framework that integrates explicit rea- soning and faithfulness verification. Our architecture augments standard retrieval with neural query rewriting, BGE-based cross-encoder reranking, and a rationale generation module that grounds sub-claims in specific evidence spans. We further introduce an eight-category verification taxonomy that enables fine-grained assessment of rationale faithfulness, distinguishing between explicit and implicit support patterns to facilitate structured error diagnosis. We evaluate this framework on the BioASQ and PubMedQA benchmarks, specifically analyzing the impact of dynamic in-context learning and rerank- ing under constrained token budgets. Experiments demonstrate that explicit rationale generation improves accuracy over vanilla RAG baselines, while dynamic demonstration selection combined with robust reranking yields further gains in few-shot settings. Using Llama-3-8B-Instruct, our approach achieves 89.1% on BioASQ-Y/N and 73.0% on Pub- MedQA, competitive with systems using significantly larger models. Additionally, we perform a pilot study combining human expert assessment with LLM-based verification to explore how explicit rationale generation improves system transparency and enables more detailed diagnosis of retrieval failures in biomedical question answering.

Protein analysis tasks arising in healthcare settings often require accurate reasoning under protein sequence constraints, involving tasks such as functional interpretation of disease-related variants, protein-level analysis for clinical research, and similar scenarios. To address such tasks, search agents are introduced to search protein-related information, providing support for disease-related variant analysis and protein function reasoning in protein-centric inference. However, such search agents are mostly limited to single-round, text-only modality search, which prevents the protein sequence modality from being incorporated as a multimodal input into the search decision-making process. Meanwhile, their reliance on reinforcement learning (RL) supervision that focuses solely on the final answer results in a lack of search process constraints, making deviations in keyword selection and reasoning directions difficult to identify and correct in a timely manner. To address these limitations, we propose ProtRLSearch, a multi-round protein search agent trained with multi-dimensional reward based RL, which jointly leverages protein sequence and text as multimodal inputs during real-time search to produce high quality reports. To evaluate the ability of models to integrate protein sequence information and text-based multimodal inputs in realistic protein query settings, we construct ProtMCQs, a benchmark of 3,000 multiple choice questions (MCQs) organized into three difficulty levels. The benchmark evaluates protein query tasks that range from sequence constrained reasoning about protein function and phenotype changes to comprehensive protein reasoning that integrates multi-dimensional sequence features with signal pathways and regulatory networks.

Objective: To improve the efficiency of medical question answering (MedQA) with large language models (LLMs) by avoiding unnecessary reasoning while maintaining accuracy. Methods: We propose Selective Chain-of-Thought (Selective CoT), an inference-time strategy that first predicts whether a question requires reasoning and generates a rationale only when needed. Two open-source LLMs (Llama-3.1-8B and Qwen-2.5-7B) were evaluated on four biomedical QA benchmarks-HeadQA, MedQA-USMLE, MedMCQA, and PubMedQA. Metrics included accuracy, total generated tokens, and inference time. Results: Selective CoT reduced inference time by 13-45% and token usage by 8-47% with minimal accuracy loss ($\leq$4%). In some model-task pairs, it achieved both higher accuracy and greater efficiency than standard CoT. Compared with fixed-length CoT, Selective CoT reached similar or superior accuracy at substantially lower computational cost. Discussion: Selective CoT dynamically balances reasoning depth and efficiency by invoking explicit reasoning only when beneficial, reducing redundancy on recall-type questions while preserving interpretability. Conclusion: Selective CoT provides a simple, model-agnostic, and cost-effective approach for medical QA, aligning reasoning effort with question complexity to enhance real-world deployability of LLM-based clinical systems.

Current biomedical question answering (QA) systems often assume that medical knowledge applies uniformly, yet real-world clinical reasoning is inherently conditional: nearly every decision depends on patient-specific factors such as comorbidities and contraindications. Existing benchmarks do not evaluate such conditional reasoning, and retrieval-augmented or graph-based methods lack explicit mechanisms to ensure that retrieved knowledge is applicable to given context. To address this gap, we propose CondMedQA, the first benchmark for conditional biomedical QA, consisting of multi-hop questions whose answers vary with patient conditions. Furthermore, we propose Condition-Gated Reasoning (CGR), a novel framework that constructs condition-aware knowledge graphs and selectively activates or prunes reasoning paths based on query conditions. Our findings show that CGR more reliably selects condition-appropriate answers while matching or exceeding state-of-the-art performance on biomedical QA benchmarks, highlighting the importance of explicitly modeling conditionality for robust medical reasoning.

Reliable epidemiological reasoning requires synthesizing study evidence to infer disease burden, transmission dynamics, and intervention effects at the population level. Existing medical question answering benchmarks primarily emphasize clinical knowledge or patient-level reasoning, yet few systematically evaluate evidence-grounded epidemiological inference. We present EpiQAL, to our knowledge the first diagnostic benchmark for epidemiological question answering over research literature, comprising three subsets built from open-access articles across diverse diseases. The three subsets progressively test factual recall, multi-step inference, and conclusion reconstruction under incomplete information, and are constructed through a quality-controlled pipeline combining taxonomy guidance, multi-model verification, and difficulty screening. Experiments on fifteen models spanning open-source and proprietary systems reveal that current LLMs show limited performance on epidemiological reasoning, with multi-step inference posing the greatest challenge. Model rankings shift across subsets, and scale alone does not predict success. Chain-of-Thought prompting benefits multi-step inference but yields mixed results elsewhere. EpiQAL provides fine-grained diagnostic signals for evidence-grounding, inferential reasoning, and conclusion reconstruction.